In a recent meeting at a rural hospital I work at, we were advised that our hospital, along with all of the others in the region, is seriously low on medications such as norepinephrine and ketamine, which are essential in treating the most critically ill patients. Norepinephrine helps sustain someone’s blood pressure, while ketamine can help us intubate someone and put them on mechanical ventilation.
We’re all familiar with the situation in New York and Italy. We’ve seen the chaos and anxiety as healthcare workers run out of personal protective equipment (PPE) and are forced to depend on donations from industry and abroad to keep themselves safe. We’ve heard the tragic stories of patients left to die because of ventilator shortages. Yet the amount of attention paid to PPE and ventilators overshadows another crisis looming for healthcare workers fighting the pandemic: In a few weeks, as we near the true peak of the pandemic, we’ll start running out of oxygen and essential medications.
Rationing these medications will lead to similar outcomes as the rationing of ventilators, a problem which has received a ton of attention, including celebrity billionaire production promises. On Tuesday morning, the prime minister announced $2 billion in support for made-in-Canada ventilators, PPE and hand sanitizer. Yet almost every sober-minded healthcare practitioner knows we’ll have to ration medication — We’ll be triaging who gets to live.
If we’re to avoid this outcome, the federal government must act now by either taking drug manufacturing into public ownership or, at the very least, directly ordering manufacturing companies to produce the essential medications we’ll need to carry on the fight against COVID-19 for the next year.
The nationalization of pharmaceutical manufacturing has been a long time coming. Even before this pandemic, drug shortages had become commonplace. Years of consolidation in the global pharmaceutical industry had consolidated supply chains and decreased the production of ‘unprofitable’ generic medications. Meanwhile, private equity firms bought up lucrative sectors of the generic market, gouging consumers for such essentials as EpiPens and insulin.
The coronavirus pandemic threatens to exacerbate this social fact, much as it threatens to do the same for every other social issue in our gilded age, from economic inequality to poor access to health care. COVID-19 has disrupted global supply chains, which has limited access to the chemical precursors needed to manufacture drugs. India and China collectively supply the vast majority of these precursors across the globe, and getting access to them has been very challenging.
A contact of mine in the federal government explained the daily calls and round the clock efforts Health Canada is making to coordinate these supply chains and work with partners across the European Union and United States to ensure we have the medications we need. But even they admit that there will likely need to be rationing of essential medications. I fear that as each country turns inward, buckling under the strain of the pandemic, such coordination and cooperation will likely fall to the wayside.
This is an extraordinary time, and it demands a robust response. Although I hesitate to use the analogy, it really must be seen as war, with the whole nation mobilizing to defeat a common, albeit invisible, enemy.
It’s been truly heartening to see the social solidarity and cooperation among the general public, as people donate PPE or come together to design cheap, open-source ventilators. I believe the same can be done for essential medications.
In fact, as recently recounted by Toronto Star columnist Linda McQuaig, our own history tells us this is possible. Almost 100 years ago, a public institute and drug manufacturer known as Connaught Laboratories decided to take a chance on a still unproven idea to use a serum from animal pancreases to treat diabetes. The lab produced the first clinical doses of insulin, which had almost miraculous effects on its first set of patients.
That story, and the ethos of the man who sold its patent to the University of Toronto for a symbolic dollar so as to ensure its affordability for years to come, is the stuff of Canadian legend, written into compact, digestible Heritage Minutes played on televisions across the country.
What often isn’t mentioned, however, is that Connaught Laboratories was founded as a public trust just before the start of the First World War to produce anti-tetanus immunoglobulin and eliminate a major cause of death for Allied forces. It was infused with federal government support and funding shortly after the Spanish flu pandemic, as the failure of public health institutions at the time became all too tragically apparent.
Connaught Laboratories remained an affordable source of global insulin for years to come, creating an international patent pooling regime that allowed the lab to ship at-cost insulin around the world. Unfortunately, it was sold to a public-private trust in 1972, and eventually privatized by then-Prime Minister Brian Mulroney before folding in as a subsidiary of French conglomerate Sanofi.
Canada should remember this history, and develop our own domestic ability to create and manufacture essential medications. A publicly-owned pharmaceutical sector would give us the opportunity to develop this capacity.
In my three years of organic chemistry studies in undergrad, I learned there are multiple ways of synthesizing any product. This means if we can’t get the usual precursors, we can look at what we have available nationally and see whether we can synthesize key medications through other pathways. Why not recruit teams of chemical engineers and chemists from across the country for this very challenge, as we’re doing with other sources for ventilators? There are obvious regulatory hurdles, but with the political will, it can all be done. The added benefit of this would be ensuring a home-grown, sustainable source of essential medications for the fight against this pandemic for years to come.
Nationalizing essential drug production is thus a collective challenge that could define our generation. It will save lives, and it will smooth out the shortage of essential medications that will lead to needless deaths. It’s also something Canada has done in the past with tremendous success.